Current Status and Activation Plan of Hospice Palliative Care in Korea - Based on Hospice Palliative Care Facilities Survey / 한국호스피스완화의료학회지

PURPOSE: This study aimed to evaluate the current status of hospice palliative care facilities in Korea. Based on the result, we attempted to suggest activation plans of hospice palliative in Korea. METHODS: To conduct a survey, we obtained a list of hospice palliative care facilities from related agencies and academic societies. A survey was conducted from February, 2009 to March, 2009. The survey was consisted of general characteristics of organizations, manpower, facilities & equipments, and so on. In addition, we used data from Statistics Korea to estimate the number of beds required and the bed occupancy rate. RESULTS: Total number of facilities responded to the questionnaire were 53. Forty-two facilities were general hospitals and 6 facilities were clinics among the total 53 facilities, and 18.8% of facilities were located in Seoul, Incheon and Gyeonggido. Overall bed occupancy rate was rather low as 21.9%, and there were 4 provinces where bed occupancy rates were 0%. Deaths in hospice palliative care facilities during 2008 were 6.3% of total deaths from cancers. As for the questions about the financial status of facilities, 86% of facilities were answered financial insufficiency. Also more than half of the facilities gave financial insufficiency as the reason for shortage of human resource supplies and inability to achieve the standard for authorization by the government. Facilities answered in order to activate the hospice palliative care, governmental support is needed, mostly in financial support (71.2%), donation tax deduction (43.1%), and setting up a public utility foundation (23.5%). CONCLUSION: This study showed low rates of hospice palliative care use and bed occupancy in Korea. Regional variance in bed occupancy rate was significantly high. As a roadblock for these problems, most of the facilities cited financial insufficiency. Therefore, there must be some action plans to boost financial support to activate hospice palliative care in Korea. Finally, efforts to improve these circumstances including lack of understanding about hospice and palliative care, are needed as well.

Prognostic Impact of Charlson Comorbidity Index Obtained from Medical Records and Claims Data on 1-year Mortality and Length of Stay in Gastric Cancer Patients / 예방의학회지

OBJECTIVES: We tried to evaluate the agreement of the Charlson comorbidity index values (CCI) obtained from different sources (medical records and National Health Insurance claims data) for gastric cancer patients. We also attempted to assess the prognostic value of these data for predicting 1-year mortality and length of the hospital stay (length of stay). METHODS: Medical records of 284 gastric cancer patients were reviewed, and their National Health Insurance claims data and death certificates were also investigated. To evaluate agreement, the kappa coefficient was tested. Multiple logistic regression analysis and multiple linear regression analysis were performed to evaluate and compare the prognostic power for predicting 1 year mortality and length of stay. RESULTS: The CCI values for each comorbid condition obtained from 2 different data sources appeared to poorly agree (kappa: 0.00-0.59). It was appeared that the CCI values based on both sources were not valid prognostic indicators of 1-year mortality. Only medical record-based CCI was a valid prognostic indicator of length of stay, even after adjustment of covariables (beta = 0.112, 95% CI = [0.017-1.267]). CONCLUSIONS: There was a discrepancy between the data sources with regard to the value of CCI both for the prognostic power and its direction. Therefore, assuming that medical records are the gold standard for the source for CCI measurement, claims data is not an appropriate source for determining the CCI, at least for gastric cancer.

The Effect of the Cost Exemption Policy for Hospitalized Children under 6 Years Old on the Medical Utilization in Korea / 예방의학회지

OBJECTIVES: The Korean government in January 2006 instigated an exemption policy for hospitalized children under the age of six years old. This study examines how this policy affected the utilization of medical care in Korea. METHODS: A total of 1,513,797 claim records from the Health Insurance Review Agency were analyzed by complete enumeration methods. The changes of medical utilization were compared from 2005 to 2006. In addition, the changes of medical utilization between 2004 and 2005 were compared as a pseudocontrol group. RESULTS: The admission rate increased 1.14-fold from 15.20% in 2004 to 17.32% in 2005, and this further increased 1.08-fold to 18.65% in 2006. The increase of patients with a common cold (1.2-fold) was higher than that of both the general patients (1.08-fold) and the patients with the top 10 fatal diseases (0.91-fold). The average length of stay per case for clinics showed the highest increase rates (1.06-fold). The rates of patients with the common cold showed a higher increase (1.05-fold) than that of the general patients. The average medical expense per case was increased by 1.10-fold from 2005 to 2006, which was higher than that from 2004 to 2005 (1.04-fold). The increase rate for patients with the common cold was higher at 1.18-fold than that of the general patients. CONCLUSIONS: The cost exemption policy has especially led to an increase in the utilization of clinics and the utilization by patients with a common cold.